IWSN Workers Compensation Handbook 2015...2015 Workers Compensation Handbook Oct 2015 Weekly Income...
Transcript of IWSN Workers Compensation Handbook 2015...2015 Workers Compensation Handbook Oct 2015 Weekly Income...
2015 Workers Compensation Handbook Oct 2015
Chapter4
AvailableBenefits
There are several types of entitlements available tosomeoneonWorkersCompensationtheseinclude:
Weeklyincomereplacements
MedicalExpenses
RehabilitationSupport
TravelExpenses
PermanentImpairmentBenefits
PropertyDamageReimbursement
*With the 2015 changes the entitlements have increased. These are expected tocome into force in December2015.Theupdatedchangesareat thebackof thischapter.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �20
2015 Workers Compensation Handbook Oct 2015
WeeklyIncomeCompensation
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �21
0–13weeks 95%ofpreinjuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings. CorrectasofApril2015.changingDec2015
14weeks–2.5years
Iftheinjuredworker’sworking15ormorehoursperweek Iftheinjuredworker’snotworking15ormore
hoursperweek
Thelesserof95%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings
Thelesserof80%ofpre-injuryearningsor$1999.30.-MinuscurrentorpotenOalweeklyearnings
2.5–5years.Theinjuredworkerneedtoapplyforongoingweeklyincomereplacements.
Iftheinjuredworkerhavenoworkcapacityindefinitely,orIftheinjuredworker’sworking15+hoursandearning$173+perweek,andareunabletoincreasehowmuchtheinjuredworkerwork/earnindefinitely
Iftheinjuredworkerhavesomeworkcapacitybutarenotworking15+hoursandearning$173+perweek,orIftheinjuredworkercouldincreasehowmuchtheinjuredworkerwork/earn
Thelesserof80%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings
Theinjuredworkersweeklyincomereplacementscease
5+years
Iftheinjuredworkerare‘aworkerwithhighestneeds’,orIftheinjuredworkerhave21–30%permanentimpairmentandeither:Havenoworkcapacity,orAreworking15+hoursandearning$173+perweek
Iftheinjuredworkerhave20%orlesspermanentimpairment,orIftheinjuredworkerhave21–30%permanentimpairmentandsomeworkcapacitybutarenotworking15+hoursandearning$173+perweek
Thelesserof80%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings
2015 Workers Compensation Handbook Oct 2015
TheInjuredWorkersentitlementsaredependenton:
Theperiod forwhich theyhavebeen receivingweekly incomereplacements
Theircapacityforworkasassessedbytheinsurer
Theinjuredworkerscurrentworkstatusand
Theinjuredworkerstotalbodyimpairmentpercentage.
Weeklyincomereplacementsandretirement
Weeklyincomereplacementscontinueforoneyearoncetheinjuredworker reach the official commonwealth retirement age with thefollowingexceptions:
If they are injured at work after they have reached the retirementage,the injuredworkerwillreceiveweekly incomereplacementsfor12 months beyond the date of their claim (if liability has beenaccepted).
Weeklyincomereplacementstoinjuredworkerswhoreturntoworkonsuitableduties
If the injuredworker ispartially incapacitated followingaworkplaceinjury and return toworkon suitable duties the injuredworkerwillearnincomeforthehourstheyworkwhileundertakingthoseduties.If this income is less thanwhat they earned before the injury thenthey may also receive a weekly workers compensation incomereplacement,oftenreferredtoas‘make-up’pay.
Can weekly income replacements be stopped orreduced?
There are several ways the injured workers weekly incomereplacementsmaystop:
Theinsurerdeniestheinjuredworker’sclaimwhiletheinjuredworkerarereceivingincomereplacement.
Theinjuredworkerreturnstofulldutiesonthesamepay.
Theinjuredworkerareassessedasbeingabletoworkformorethan15hoursaweek(wethertheinjuredworkerhaveajobornot). Their weekly income replacements may be reduced tomatch what they insurer considers to be the injured workersearningcapacity.
Theinjuredworkerarenotaworkerwithhighestneedsbutarenot working and have reached the two and a half yearthreshold.
The injured worker are not a worker with highest needs, andhavereachedthe5yearthreshold.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �22
2015 Workers Compensation Handbook Oct 2015
Usingsickpayandannualleave
Aworker can use their sick leave or other leave entitlementswhilethey are waiting for entitlements to be paid. Depending on theirenterpriseagreementtheymaybeabletotopuptheircompensationif the rate drops. Check the employment award or enterpriseagreement.
Annualleaveandentitlements
While they are still working (on the books of their employer). Aninjured worker is entitled to receive, in addition to their WorkersCompensationentitlements:
Annualleave
Publicholidays
Longserviceleaveprorata,whileemployed
But:Theycan’tbepaidsickleaveandcompensationsimultaneously
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �23
2015 Workers Compensation Handbook Oct 2015
MedicalorrelatedexpensesInjured workers are entitled to have all their reasonable medicalexpenses paid by the insurer up to 2 years* after the insurer hasstoppedtheinjuredworkersweeklyincomecompensation.
Treatment by medical practitioners, physiotherapists,chiropractors, osteopaths, psychologists, counsellors, exercisephysiologists,massagetherapists,otherhealthpractitioners
Domesticassistanceservices
Nursing, medical and medicine supplies (provided outside ofhospitaltreatment).
Most treatment requires prior approval, however some treatmentdoesnotrequirepriorapproval.Thesemayinclude:
Treatment provided within the first 48 hours following theinjury
Consultation with the nominated treating doctor (with theexceptionofmentalhealthconsultationsusingtreatmentitemsAA905andAA910)
The first consultation and treatment provided within thatconsultationwiththefirstspecialistmedicalpractitioner
Pharmacyitemsprescribedbythenominatedtreatingdoctororspecialistmedicalpractitionerinthefirst3weekspostinjury,toamaximumof$500andforpharmacyitemsexcludedfromthePharmaceuticalBenefitsSchemetoamaximumamountof$100
*fromDecember2015seenotesattheendofthischapter
All plain x rays performed on referral from the nominatedtreating doctor or specialistmedical practitioner in relation totheinjuryclaimedandprovidedwithinoneweekofinjury
Services provided in public hospital's that are provided by orconsequent upon presentation at the hospital's emergencydepartmentfortheinjuryclaimedthatarewithinonemonthofthedateofinjury
Some consultations for physiotherapy, osteopathy orchiropractictreatment
Somepsychologytreatmentorcounselling.
Itisadvisablethattheinjuredworkerandtheirdoctorformulateaninjurymanagementplancoveringmedicalinvestigation,treatmentrecoverand/oradaptationtotheinjuryasearlyaspossibleandprovidesthistotheinsurer.
Medicalentitlementstable*:
Permanent impairment percentage as of Dec 2015
10% 2 years from when weekly income replacements cease (or from date of claim if no weekly income replacements were made).
11-20% 5 years rom when weekly income replacements cease (or from date of claim if no weekly income replacements were made).
20% or more Medical entitlements are for life.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �24
2015 Workers Compensation Handbook Oct 2015
ArtificialAids,Home&VehicleModificationsLifelong access for all approved claims for access to artificial aidssuchasprostheticscrutcheseyesorteethhearingaidsandbatteries,other artificial aids, and home and vehicle modificationsIn (as ofDecember2015)
HospitaltreatmentHospitaltreatmentincludestreatmentatpublicandprivatehospitalsand/orrehabilitationcentres.
AmbulanceservicesAmbulance services include emergency, non-emergency and interhospitaltransfersprovidedbytheAmbulanceServiceofNSW.
SecondarySurgery:Is available for all injured workers who require secondary surgicalprocedure on the part of the body affected by the earlier surgery.Thismustbeapprovedbytheinsurerwithintwoyearsoftheearliersurgery(butdoesnotneedtooccurwithinthosetwoyears).inforceasofDec2015.
WorkplacerehabilitationservicesWorkplacerehabilitationservicesinclude:
Returntoworkandcasemanagement
Vocational,functionalandworkplaceassessments
Jobanalysisandmodification
Identificationofsuitableemployment
Workerretrainingandplacementinsuitableemployment.
Remember: the choice or rehab provider is theinjuredworkers.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �25
2015 Workers Compensation Handbook Oct 2015
TravelExpensesTo claim for payment for travel to attend medical, hospital andrehabilitationappointments,theinjuredworkerwillneedtokeep:
Arecordofthemileageiftheworkeruseshis/hercar
Receiptsforpublictransport.
Themaximumamountpayable forprivatecar travelassociatedwithattending medical, hospital and rehabilitation appointments isreviewedevery12months.
Forovernight tripsor trips involvingplaneor lengthy travel insurersshouldorganiseandpayfortheseinadvance.
PropertyDamageExpenses:
Damagetoartificialaids
If artificial eyes, false teeth, crutches, artificial limbs, other artificialaidsorspectaclesaredamagedinaworkrelatedaccident,aninjuredworkermaybeentitledtocompensation.
Thismayincludethe:
Reasonable cost of repair or, if necessary, replacement of theartificialaid
Service costs of qualified persons for consultations,prescriptionsandexaminationsinconnectionwiththerepairorreplacementoftheartificialaid
The loss of wages associated with attending consultations,prescriptionsandexaminationstorepairorreplacetheartificialaid.
Themaximumamountpayablefordamagetoartificialaidsis$2000.Thisamountcanbeincreasedonacase-by-casebasisbyWorkCover,orbyadirectionfromtheWorkersCompensationCommission.
DamagetoclothingIf an injured worker have a work related accident, they may beentitledtocompensationfortherepair,or ifnecessary,replacementofclothingdamagedintheaccident.
Themaximumamountpayable for damage to clothing is $600. Thisamountcanbeincreasedonacase-by-casebasisbyWorkCover,orbyadirectionfromtheWorkersCompensationCommission.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �26
2015 Workers Compensation Handbook Oct 2015
PermanentImpairmentBenefits:Ifaworkerhasapermanentimpairment(anacquireddisability)asaresultofaworkplaceinjuryorillness,theymaybeentitledtoreceiveapaymentundersection66oftheWorkersCompensationAct1987ifthey have suffered 10% if a physical disability or 15% if apsychologicaldisabilityormorepermanentimpairment.Theamounttheinjuredworkermayreceiveis:
IndicativeasofOctober2015.
SuingforNegligence(commonlaw):Beforeaninjuredworkercansuetheiremployerfornegligencetheymust meet a total body impairment of 11% for physical injury and15%forpsychologicalinjury.
Injured workers will need to employ a solicitor to run the case atcourt.
Initially,theWorkersCompensationCommissionattemptstomediateandreachsettlementthroughdiscussionswithandagreementofallparties.Ifanagreementisunabletobereached,workinjurydamagesclaimsareheardintheWorkersCompensationCommission.
If a work injury damages claim is not successful, the worker willcontinue to receive workers compensation under the statutoryscheme, butmay be liable for court costs incurred during theworkinjurydamages claim (this is rarebut consult a solicitor to knowalltherisks.
Ifaninjuredworkerthinkstheymaybeeligibletolodgeaworkinjurydamages claim and would like to proceed, they should first seekindependentlegaladvice.Iftheinjuredworkerareunsureofhowtolocateasuitable legal representative,An injuredworkercancontacttheir Union for legal representation of (if they aren't a unionmember)theWorkCoverIndependentReviewOffice.
Impa i rmen tpercentage
M i n i m u mpayment
M a x i m u mpayment
10%to30% $19,540 $78,340
31%to50% $83,040 $175,000
51%to55% $242,010
56%o60% $309,02061%to65% $376,03066%to70% $443,03070%to74% $510,04075%andabove $577,050
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �27
2015 Workers Compensation Handbook Oct 2015
Commutation:A commutationpayment iswhere an insurer and an injuredworkeragreetoalumpsumpaymentratherthanongoingweeklypayments.Itcanonlyoccurif:
The injuredworkers total body impairment percentage is 15%orover
Two years have passed since the claim was accepted (with aminimumofsixmonthsofweeklyincomereplacements)anditwillbeongoing.
Allopportunitiesforinjurymanagementandreturntoworkfortheinjuredworkerhavebeenexhausted
Theinjuredworkerhasreceivedindependentlegaladviceaboutthecommutationoffer.
Commutation payments bundle up all future payments the insurermayoweaninjuredworkerintoasingle,oneoffpayment.
Notes:
Itisadvisablealwaystoconsultwiththeirunionlawyersbeforetakinganyactionagainstanemployeroraninsurancecompany.OnewillbeneededtoapproachtheWorkersCompensationCommission.
The WorkCover Independent Review Office will pay for legalrepresentationatthecommission.AlistofeligiblelawyersisavailableontheWIROwebsite.
DeathBenefits:In the unfortunate circumstance of a death of a worker there arethreeentitlementsavailable:
A lump sum payment of $750,000 to the dependents of thedeceased worker. (this applies to fatalities on or before 5August2015)
Reasonable funeral expenses of up to $15,000 (this applies tofatalitiesonorbefore5August2015)including
FuneralDirectorsfees,
costofthefuneralservice
Coffin
Mourningcar
Cemeterysite
Flowers
Newspapernotice,and
Deathcertificate.
Weeklycompensationof$135.30perdependentchild*
*Adependentchildisdefinedasachildorstepchildofaworkerwhowaswhollyorpartially dependent for support on them at the time of the workers death. Adependentchildmaybeentitledtoweeklysupportpaymentsuntiltheyreachtheageof16or,iftheyremainastudent,untiltheageof21.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �28
2015 Workers Compensation Handbook Oct 2015
October/December 2015Changes toBenefitsWeeklyIncomeCompensation:
IndicationasofDecember2015.
The Injured Workers Support Network www.injuredworkerssupport.org.au Page �29
Injuredworkerswithhighestneeds(30%TBI) Minimumof$788.32perweek
0–13weeks 95%ofpreinjuryearningsor$1999.30-MinuscurrentorpotenSalweeklyearnings.
14weeks–2.5years
Iftheinjuredworker’sworking15ormorehoursperweek
Iftheinjuredworker’snotworking15ormorehoursperweek
Thelesserof95%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings
Thelesserof80%ofpre-injuryearningsor$1999.30.-MinuscurrentorpotenOalweeklyearnings
2.5–5years.Theinjuredworkerneedtoapplyforongoingweeklyincomereplacements.
If:Theinjuredworkerhasatotalbodyimpairmentofover20%.Hasnoworkcapacityindefinitely,orIIftheinjuredworker’sworking15+hoursandearning$173+perweek,andareunabletoincreasehowmuchtheinjuredworkerwork/earnindefinitely.
If:Theinjuredworkerhasatotalbodyimpairmentofunder20%Hassomeworkcapacitybutarenotworking15+hoursandearning$173+perweek,orIftheinjuredworkercouldincreasehowmuchtheinjuredworkerwork/earn.
Thelesserof80%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings Theinjuredworkersweeklyincomereplacementscease
5+years
Iftheinjuredworkerare‘highneedsorhigherneeds”(20%TBIorhigher)
Iftheinjuredworkerhave20%orlesspermanentimpairment,
Thelesserof80%ofpre-injuryearningsor$1999.30-MinuscurrentorpotenOalweeklyearnings Theinjuredworkersweeklyincomereplacementscease
ReSrement AworkerisenStletoupto12monthsofweeklyincomereplacementsofcompensaSonaTerreachingreSrementage.